Provider Demographics
NPI:1629305495
Name:AZI HOUSE LLC
Entity Type:Organization
Organization Name:AZI HOUSE LLC
Other - Org Name:AZI HOUSE ONE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:STATUTORY AGENT
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:ATABONGNKENG
Authorized Official - Last Name:FUANGUNYI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:240-643-0815
Mailing Address - Street 1:5986 S JAKEMP TRL
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85747-6003
Mailing Address - Country:US
Mailing Address - Phone:240-643-0815
Mailing Address - Fax:
Practice Address - Street 1:6914 S BITTERCRESS RD
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85756
Practice Address - Country:US
Practice Address - Phone:240-643-0815
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-11-15
Last Update Date:2019-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities